Endocrine Abstracts (2011) 26 P264

Transition to endoscopic transsphenoidal pituitary surgery: a single-center experience

W Billmann1, S Bilz1, A von Hessling2, A J Tasman3, M Brändle1, G Hildebrandt4 & J Y Fournier4


1Division of Endocrinology, Diabetes and Osteology, Department of Internal Medicine, Kantonsspital St Gallen, St Gallen, Switzerland; 2Departement of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland; 3Department of Otorhinolaryngology, Head- and Neck Surgery, Kantonsspital St Gallen, St Gallen, Switzerland; 4Department of Neurosurgery, Kantonsspital St Gallen, St Gallen, Switzerland.


Background: Surgery of the pituitary gland is increasingly being performed through an endoscopic approach. We report the results of the first 26 patients after transition from microsurgery to endoscopic transsphenoidal surgery at our institution.

Methods: Medical records of 26 consecutive patients (13 females) with a median age of 59 years who underwent endoscopic transsphenoidal surgery by a single surgeon from 2008 to 2010 and had a follow-up of at least 3 months were reviewed retrospectively.

Results: Fifteen patients (58%) presented with clinically non-functioning macroadenomas, 7 (27%) with hormone secreting tumors and 4 (15%) intra- or suprasellar cysts. Complete tumor resection was achieved in 10 patients (39%), near total resection (residual tumor volume <1 cm3) in 8 (31%) and partial resection in 6 (23%, 2 missing). Visual fields remained intact in 46%, returned to normal in 12%, improved in 23% and showed no change in 15% (1 missing). Pituitary function was not affected by surgery in 18 patients (69%). Complete resolution of partial hypopituitarism was noted in 3 patients and partial recovery in 2. Three patients developed partial hypopituitarism (12%) and one a permanent diabetes insipidus. In patients with hormone secreting tumors (7) remission was noted in 3 (2 with Cushing’s disease, one with acromegaly), whereas further therapy was necessary in 4. Perioperative complications occurred in 16 patients (62%). Disturbances of salt and water metabolism were noted in 12 patients. CSF leaks occurred in 5 patients and required repeat surgery in 2. Three patients had an infection in their postoperative course.

Conclusions: Significant tumor reduction can be achieved by the endoscopic approach while endocrine function is maintained or improved in the majority of patients. The high incidence of perioperative complications was mainly due to transient salt and water disorders.

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